Neuropediatrics 2019; 50(06): 353-358
DOI: 10.1055/s-0039-1693059
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Ketogenic Diet and Its Effect on Bone Mineral Density: A Retrospective Observational Cohort Study

Jos M.T. Draaisma
1  Department of Pediatrics, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
,
Brieke M. Hampsink
1  Department of Pediatrics, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
,
Marcel Janssen
2  Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
,
Nicole B.M. van Houdt
3  Department of Gastroenterology and Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands
,
E. T.A.M. Linders
4  Department of Pediatric Neurology, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
,
Michèl A. Willemsen
4  Department of Pediatric Neurology, Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
› Author Affiliations
Further Information

Publication History

03 April 2019

30 May 2019

Publication Date:
09 August 2019 (online)

Abstract

Background During long-term follow-up of children treated with the ketogenic diet therapy (KDT) have an increased incidence of bone fractures. However, the exact contribution of KDT to a decreased bone mineral density (BMD) remains unclear.

Objective This study aimed to evaluate (changes in) BMD in children treated with KDT and to evaluate whether intravenous bisphosphonate therapy may be effective.

Design In this retrospective, observational cohort study, all children treated with KDT from 2010 until 2018 at the Radboudumc Amalia Children's hospital were included. Patients who were on KDT for more than 6 months and who had at least two dual-energy X-ray (DXA)-scans were eligible for inclusion for longitudinal analysis. Z-scores of DXA-scans were compared over the course of time.

Results In 34 out of 68 patients, one or more lumbar DXA-scans were performed, with a mean lumbar Z-score of −1.32 ± 1.74. Of these 68 patients, 8.8% got a fracture during KDT, and also 8.8% got kidney stones. In 20 patients, more than one DXA-scan was performed. A statistically not significant decrease in BMD (0.22 Z-score/year) was found. However, there was an increase in BMD in the five patients treated with intravenous bisphosphonate therapy. This was statistically significant in comparison to the nonbisphosphonate treated group (p = 0.034).

Conclusion Children on KDT have low normal BMD which may decrease further during KDT. For this reason monitoring of BMD is crucial, as is monitoring of kidney stones and hypercalciuria. Intravenous bisphosphonate therapy may have a positive effect, when other therapies have failed.